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Medical Data Reviewer
ICON plc is a world-leading healthcare intelligence and clinical research organization. We’re proud to foster an inclusive environment driving innovation and excellence, and we welcome you to join us on our mission to shape the future of clinical development
Senior Medical Data Reviewer
Homebased
Key Responsibilities:
Collaborate closely with Medical Leads and Clin...

A vital role of the CMO Administration team, the Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations.
Duties/Responsibilities:
* The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records an...

Company Overview
Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.
Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership...

Saratoga Medical is hiring a Medical Case Reviewer (PhD) in Remote. Package includes competitive rate, paid time off and benefit options.
Saratoga Medical has an exciting opportunity for a Medical Case Reviewer (PhD) at Remote. This is a great full-time opportunity. Please see qualifications below and submit your resume if you are interested in being considered.
Performance Work Statement (...

Saratoga Medical is hiring a Medical Case Reviewer (MD) in Remote. Package includes competitive rate, paid time off and benefit options.
Saratoga Medical has an exciting opportunity for a Medical Case Reviewer (MD) at Remote. This is a great full-time opportunity. Please see qualifications below and submit your resume if you are interested in being considered.
Performance Work Statement (PW...

Responsibilities:
Under the direction of the supervisor, the Clinical Care Reviewer UM is responsible for completing medical necessity reviews. Using clinical knowledge and experience, the Clinical Care Reviewer UM reviews the provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medi...

JOB TITLE (# 25023 ): Emergency NP / VA Reviewer - Remote
Minimum of 5 years active clinical practice within the specialty and 2 years of recent experience
Greenlife Healthcare Staffing is currently seeking an Emergency Nurse Practitioner - VA Reviewer to fill an opening with a Non-profit organization
Requirements of the Emergency NP / VA Reviewer :
* Must hold a current, non-...

JOB SUMMARY
The Credentialing Assistant is responsible for screening reviewers for required credentialing and background information, including professional sanctions and criminal background information. The position requires coordination between multiple departments at Dane Street to provide support relating to the information, data, and standards involved in reviewer credentialing.
Dane Stree...

The Surgery Clinical Reviewer coordinates, collects, and submits reliable and accurate clinical data to the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP), through high-quality, complex clinical data interpretation, abstraction, and data validation. This position obtains data via standard and custom reports, analyzes, interpret data's, and identifies opportu...

Optim Health System is seeking (2) full time Certified Coder/Surgical Case Reviewer(s). This is a remote position.
JOB TITLE: Surgical Case Reviewer: Certified Coder
SUPERVISION RECEIVED: Reports directly to Patient Access Director
SUPERVISION EXERCISED: None
TYPICAL WORKING CONDITIONS: Remote
ESSENTIAL DUTIES AND RESPONSIBILITIES: (This list may not include all of the duties assigned.)
...

Overview
Lead Quality Reviewer
The Lead Quality Reviewer serves as the individual coordinating training for new client Electronic Medical Record (EMR), Quality Reviewers, and assisting with claims eligibility inquiries. This position compiles monthly 340B compliance reviews for distribution, as well as completes routine reviews of prescriptions to determine if established 340B eligibility has...

LOCATION: Remote – this is a home based, virtual position. This person must live in North Carolina or within 40 miles of the North Carolina border.
GENERAL STATEMENT OF JOB
The Psychologist Peer Reviewer is part of the Utilization Management Team who conducts Peer Reviews and fulfills multiple other functions involved with service reviews and appeals, ensuring that Vaya Health (Vaya) adher...

Job Category:
Revenue Cycle
Work Shift/Schedule:
8 Hr Morning - Afternoon
Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
About the Role:
Job Summary
The Coding Quality Reviewer II is responsible for performing quality analysis of coded medical records, documenting the analysis, summarizing the metrics and reporting quality statisti...

The Data Reviewer Specialist acts as a contributing specialist for studies, with the ability to carry out aspects of data review, expediting audit responses, and reporting (data reviewing with minimal guidance) through report finalization. The Data Reviewer Specialist has excellent organizational skills and utilizes a strong base in regulatory policy to assess data review and reporting and main...

Current SIH employees need to apply for positions through our internal job portal. Log in to Workday to apply through the Jobs Hub.
Position Summary
* The Clinical Documentation Improvement Second Level Reviewer is a Professional Registered Nurse with a broad clinical knowledge base and understanding of DRG documentation requirements who works under the supervision of the CDI Manager. R...

JOB SUMMARY
The QA Specialist plays an integral role in the review process as they are responsible for communicating with the customer, reviewer, and management to ensure a completed report is delivered by the customer requested due date.
The QA Specialist is responsible for the timely completion and overall completeness of a reviewer report. Completeness is determined by customer requirements,...

013650 CCA-Auth & Utilization Mgmt
Position Summary:
Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS compliance standards in the area of servic...

JOB SUMMARY
The Quality Analyst is responsible for managing the various aspects of the medical file review process. They will review the completed referral to ensure client questions have been addressed appropriately and review the completed report for accuracy. Ensuring client and department standards have been met.
Dane Street's success relies on individual and team contributions every day. W...

JOB SUMMARY
The Customer Service Representative is responsible for receipt of new cases and ensuring proper system drafting and setup. The CSR also is responsible for taking direction and facilitating the case assignment/scheduling process.
Dane Street's success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility...

CRIO (Clinical Research IO) is a health tech company helping pharma, biotech, research sites, and academic research centers streamline regulatory workflows with one system and a single source of clinical data capture. Our modules allow sites to capture data electronically in real-time, providing data managers and monitors with enhanced transparency, and enabling remote monitoring by sponsors an...